More on HIV and Poverty in the U.S.

Many years ago, some friends of mine in Israel dug a hole. I don’t remember now what they were searching for, but they thought there was something a ways down, so they dug. It took a while, and in the end they had a very deep hole. But, what they had been looking for turned out to not be there. So now they had a hole with nothing to show for it. Someone came up with a very surprising way to make use of the hole. Again, sorry, I don’t remember the details, but it was something wonderful. And the wisdom of the moment was: Why waste a good hole?

My last post was a brief survey of the landscape connecting HIV and poverty, with a selection of slides from a talk I was about to give at the American Association for the History of Medicine meeting. Having gathered together the information, I thought I’d post the remainder, because why waste a good slide.

You know how there are some topics which, when you come across them, you think: why aren’t we talking about this every day? How can the world just kind of keep going on when this problem exists? How is it possible that someone is spending more than $100 million dollars to keep The Scream in a private collection, or to ensure someone’s election into office, when there are children being born into situations that put them at high risk for diseases that they’ll spend their entire lives coping with, or from which they will die way too young? It’s not that I think the people spending that money should be directing it elsewhere; it’s that we live in a world where economy trumps humanity at every turn. I know, I know, this is a blog about science, not social justice, but sometimes a topic arises where the two can’t be kept separate.

There are a zillion issues like this, too many to name, or almost think about. Admittedly, delving into the many health disparities connected with poverty isn’t something I do every day. But having gone there, I’m finding it hard to leave.

Anyway. Onto the slides.

In the last post, I included some stills from this moving portrait of how HIV has shifted over the past two decades. Here are some more statistics about that:

The AIDSVu project, conducted by Emory University, found that nearly all U.S. counties with high rates of HIV and infection are located in the south. To be more exact, of the 175 counties in the top 20% for HIV and poverty, all but six are in the south.

According to the 2010 CDC report, Communities in Crisis, heterosexuals living below the poverty line in U.S. cities are five times as likely as the general population to be HIV-positive, regardless of race of ethnicity. Among people living in the same neighborhood but above the poverty line, the likelihood of being HIV positive was 2.5 times higher than among the general U.S. population.

Here is another way to consider the overlap of poverty and race/ethnicity:

So, the CDC is saying that the main connection between HIV and race/ethnicity is through the conduit of poverty. When you look at the entire U.S., HIV rates are staggeringly higher among blacks. But when you zero in on poverty, the racial/ethnic disparities almost disappear. Similarly, sexual orientation becomes less of an issue. In that CDC study, which was based on 9,000 people in 23 cities, 2.1% of heterosexuals living in high-poverty urban areas were HIV positive. Note that the definition of an epidemic is when the rate of a disease in a given location exceeds 1%.

The last post also mentioned that HIV is one of many diseases of poverty. Of course this is looking only at the U.S.—when you extend the view to the entire world, the connection becomes only more harrowing, as shown very starkly in this WHO report, Disease of Poverty and the 10-90 gap. (PDF) (10-90, as in: 10% of the world’s population get 90% of the healthcare.)

In the U.S., diabetes is another disease connected with poverty. Here is a slide that was included in the last post showing the prevalence of diabetes in the U.S.:

The map above covers all regions of the country where income spans from $19K/year to $112K/year.

Now here is a version of the map filtered to include areas where the average income ranges from $19K/year to $34K/year:

The two maps reveal the areas where lower-income plus diabetes incidence are most concentrated.

A major issue inside this territory is that of education. Educational disparities are also linked to disease. Having not really done much research to better understand, in a clear and factual way, why poverty and education and disease seem to be linked together, I’m not going to assume any explanation. But here are some small glimpses that show the link exists.

I hope you can see this slide clearly enough. It shows the potential number of deaths from cancer that could have been prevented by eliminating educational and/or racial disparities among people ages 25–64 in 2007:

The light blue in the charts above, which you’ll note encompasses more than half the pie for African American men, shows the deaths that supposedly could have been avoided.

Among the 10 states with the lowest high school graduation rates (less than 65%), seven are in the southern U.S. Whether that bears any direct relevance to HIV rates in those states, I don’t know.

Here’s some more interesting information, now focused on sex education. There are a lot of states that don’t mandate sex education or HIV education.

For a better view of that, a PDF is available here, with a lot more information about where American teenagers get information about sex. Several states in the U.S. allow abstinence-only sex education.

Here is more about the link between education and health, from the National Poverty Center (PDF).

Finally, some more information about healthcare among people living with HIV.

The CDC recommends HIV screening as part of routine medical care. Yet in many states, Medicaid does not cover routine HIV screening. According to the CDC, “States in the South were least likely to cover routine HIV screening (4 of 16).” This map shows where such screening is (dark blue) and isn’t (light blue) covered:

Finally, a look at poverty rates across the country. According to the U.S. Census Bureau, rates are rising faster in the southern U.S. than in other regions. From 2009 to 2010, there was a 1.2% rise in poverty in the South, about double the rise seen in the Northeast, Midwest, or West. The share of the U.S. population earning below half of the federal poverty line has risen to 6.7%, a record high.

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